Provider Demographics
NPI:1780953190
Name:APPLE, JEFFREY WALTER (ATC, LMT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WALTER
Last Name:APPLE
Suffix:
Gender:
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1818
Mailing Address - Country:US
Mailing Address - Phone:484-329-6919
Mailing Address - Fax:
Practice Address - Street 1:446 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1818
Practice Address - Country:US
Practice Address - Phone:484-329-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2025-03-05
Deactivation Date:2018-03-20
Deactivation Code:
Reactivation Date:2024-04-24
Provider Licenses
StateLicense IDTaxonomies
PAMSG013470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist